Endogenous mechanism

Place of somatostatin in the treatment of AS is determined by its main pharmacodynamic properties, which include:

1. suppression of secretion of acid and pepsin in the stomach (prevention of stress ulcers);
2. suppression of secretion of pancreatic function (prevention of pancreatic necrosis);
3. suppression of release of gastrointestinal hormones tissue;
4. reduction of pressure in the portal venous system;
5. tsitokinogeneza blockade.

Not being able to dwell in detail on other aspects of treatment of intestinal insufficiency syndrome, we stress that its success is impossible without adequate metabolic support and optimal oxygen transport - as an integral and splanhnicheskogo.

3. Antibacterial Therapy

Antibacterial therapy for the AU in its essence plays the same role as the cessation of bleeding in hemorrhagic shock. Of course, the antimicrobial agents do not affect the running mechanism of the systemic inflammatory response and explosive mediatoza. The problem of antibiotic therapy - etiotropic direction, blocking the systemic inflammatory cascade at the level of its exogenous microbial mediators. It is therefore ineffective antibiotic therapy 2 times increased mortality in the AU [7.16].

As shown by studies conducted in our clinic, inadequate antimicrobial therapy has a large pharmaco-economic value - increasing the cost of drug treatment by 89% and the total cost of hospital treatment increased by more than 30%.

Antibiotic therapy may be ineffective due to various circumstances.

After analyzing the reasons for failure of antibacterial therapy, we rubrifitsirovali them as follows:

1. Antibiotics have no effect on pathogens.

II. Lack of bioavailability of drugs at the source of infection and local dissemination of microorganisms.

III. Development side and toxic effects with antimicrobial agents.

In group 1 the causes of failures of particular importance is the fact that antibiotics are often prescribed without mandatory polymicrobial etiology of AS involving aerobes and anaerobes, focusing on incorrect data bacteriological studies, including those associated with the phenomenon of cultural resistance. Plays an important role and change of priority agents in the treatment of the AU and the development of antibiotic resistance during treatment. Appropriate to emphasize the clinical significance of enterococcal superinfection on the background of the original effective therapy AU aminoglycosides, cephalosporins, fluoroquinolones.

With regard to the development of resistance, our brand viagra studies have shown different frequency of this phenomenon during treatment with penicillins, cephalosporins, imipinema, fluoroquinolones and aminoglycosides: for semisynthetic penicillins, it is 9,2%; cephalosporins II-III generation - 8,6%; imipinema - 4 , 7%, ciprofloxacin - 11.8%; aminoglycosides generation III - 13,4%.

Failure of therapy may be related to the inclusion of an endogenous mechanism of translocation of bacteria and development of alternative foci of infection such as nosocomial pneumonia in patients with peritonitis. This circumstance, first, expanding and changing range of priority pathogens of sepsis, and secondly, the impact on the delivery of antibiotics in the foci of infection. Established that the fractional penetration of antibacterial drugs in different anatomical areas is significantly different, and this leads to a significant reduction in the effective bactericidal concentration at the source of infection [17].

Group II causes of failures due to lack of bioavailability of drugs at the source of infection. This may be due to:
1) the wrong mode of introducing drugs without regard to their kinetic properties;
2) changes in pharmacokinetics under the influence of fluid therapy, forced diuresis and syndrome of capillary leak, the use of extracorporeal detoxification;
3) lack of transport proteins (albumin);
4) violation of the systemic and regional blood flow, especially in the foci of infection;
5) formation of a protective "traps" for microbes (units, microthrombi, protein deposits).

The latter circumstance has played a leading role in the emergence against the background of the AU angiogenic foci of infection that is resistant to the ongoing antibiotic therapy.

Finally, III group of failures related to the toxic effects of antibiotics, exacerbating multiple organ failure characteristic of the AU. Unfortunately, antibiotics have a greater or lesser degree of side effects and organotoksichnostyu. Neither a clinical situation does not create more problems when choosing the most effective and most toxic antibiotic therapy than is the case in the surgical, in particular, abdominal sepsis.

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